Project: Terre des Hommes Integrated e-Diagnostic Approach programme (IedA)
Purpose: Improve the clinical management of children under five in primary health settings.
Location: Burkina Faso
Partners: The four-year project is funded by the Bill and Melinda Gates Foundation, and implemented on the ground by Terre des Hommes. All consultations are provided by local Ministry of Health staff. Dimagi was responsible for all technical aspects of REC, including the mobile platform built on CommCare, which enables diagnostic and treatments, coaching and supervision, and helpdesk via Android tablets. Other players include the London School of Hygiene & Tropical Medicine (LSHTM), who is in charge of impact assessment, and the University Research Co. LLC (URC), who is responsible for the implementation of the quality assurance. The Novartis Foundation and UNICEF have also contributed to the project, and other partners like Global Fund have become involved recently for the scaling activities.
Overview: Reducing Child Mortality in Burkina Faso
In 2010, one in 10 children in Burkina Faso died before the age of five, mainly due to lack of access to quality health care services.
Terre des Hommes started the Integrated e-Diagnostic Approach programme (IeDA) in 2014, with the goal of reducing child mortality by enabling better quality of health services through mobile health tools, quality improvement processes and a data management strategy.
The project addresses the poor quality of child health services in Burkina Faso by increasing the level of adherence to the Integrated Management of Childhood Illnesses strategy (IMCI), developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).
IeDA combines information and communication technologies using the REC (Registre Électronique de Consultation) an electronic IMCI patient record designed by Terre des Hommes, and a quality improvement approach. Before 2014, the approach has been piloted over three years in two different districts in the north of Burkina Faso, Tougan and Séguénéga. The success of the approach was reported to the Ministry of Health who requested Tdh to scale the solution.
How’s the project going today? We checked-in with Guillaume Foutry, IeDA Project Director, for a progress update. Read the Q&A below to learn more about the project, how it has scaled, key takeaways from the implementation, and where the project is headed next.
Q&A with Guillaume Foutry, Project Director on the IeDA project.
Scale: how big is the project today?
[Foutry] IeDA is now deployed in six districts and 272 csps, which represents 13 percent of the national coverage. The REC app is used by 1,800 active CommCare users, who have completed 1,000,000+ consultations and registered over 500,000 children since December 2014.
In the latest assessment report of this project, LSHTM found there has been an increase of between 30 percent and 50 percent in the quality of care with the REC. The researchers also found that IeDA facilitated a rapid adaptation to protocol changes, meaning decisions can be easily made, based on the data collected in the 850,000+ consultations. The overprescription of antibiotics has also been reduced thanks to more accurate diagnostic and associated treatment.
REC Data has also been integrated into the national Health Management Information System, ENDOS (local DHIS2) integration: 45 indicators are instantaneously visible in ENDOS, A Performance Management Platform (i.e. e-learning platform) is currently being implemented, to support capacity building for CHWs. Learning modules are assigned to users based on their performances from using the REC.
Deployment on this project is ongoing, as we plan to extend our coverage and include 600+ clinics by the end of 2017, which would represent 30% of all clinics in the country.
Key Takeaways: what were three key learnings from the project?
[Foutry] Working on this project over the past few years we have learned a lot about what works and what doesn’t work when implementing an app for community health workers. These were our three main takeaways:
- Do not focus on the technology only: Integrate the human factor: we are building a tool, but people are going to use it. Things to think about are: How do we train them? How do we collect their feedback? How do we understand their challenges?
- What will motivate people: It’s important to be clear on the value that a new tool will add to people and organizations. We thought that money would be the number one incentive for CHWs, but we realized that reduced workload, sense of contribution, prestige to use a tech tool, certificates and tee-shirts were great motivators.
- Data, Data, Data: Data management is probably the easiest part of such a project to overlook/underestimate. We found it was worthwhile to recruit an experienced Data Manager and budget additional funding for different types of dashboards.
- When working with Ministries of Health, communication, involvement, and transparency are key. Ministries of Health have many competing priorities. We found it to be extremely important to take this into account and understand that IeDA was one project among many for them. Try to understand the players, the dynamics within the MoH, and who could be champions for the project within the MoH. Also, if you understand their needs and goals, you can work to make your project fit into that: connect your project to their other initiatives.
What’s next for IeDA in Burkina Faso?
[Foutry] In 2017 we plan to deploy the REC in 600 CSPS and 10 Districts, which will represent 30 percent of national coverage! On our roadmap for this year we also plan to finalise the guide and resources to transfer our work over to MoH, taking into consideration all components: processes, technology tools, cost. We also plan to complete Endos Integration, deploy PMP m-learning platform, and to deploy the REC in 38 clinics in Mali. It’s going to be a busy year!
As for further in the future, IeDA hopes to eventually cover 946 CSPS, which would represent 45% of the national coverage. We also expect REC to add a Malnutrition Protocol and create dedicated modules for malaria and vaccines. The next goals are as follows:
- Complete REC Server setup in Burkina Faso
- Complete Transfer to MoH so that IeDA becomes a MoH programme
- Complete REC deployment in Mali
- Launch REC pilot project in Mauritania
- Use the REC as an Early Alert system
- Develop a Universal Patient Record System, based on the REC
- Develop a Pharmacy and Stocks Management system
What do you think the impact on this project could mean for others? For example, now that there are health records for all of these children under the age of five, how could other organizations tap into that information to help provide better care?
[Foutry] REC is now receiving requests for connexion and/or integration with other information systems. First, integrating the REC with the national HMIS (DHIS2) is a huge win, as data collected via mobile in all health facilities would be immediately visible at the national level, facilitating data-driven decisions.
Another great example of how this technology could be used is by researchers from Polytechnical School of Lausanne (EPFL), who want to use the REC as pilot system to build a mobile application which can estimate the height and weight of children based on pictures, easily and precisely.